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Characterization of a cohort of patients with hypercalcemia in a tertiary pediatric hospital
Ana Feller1, Mariana Aziz1, Silvia Gil1
1Department of Endocrinology, Hospital de Pediatría S.A.M.I.C. Prof. Dr. Juan P. Garrahan, City of Buenos Aires, Argentina.
Insights
Pediatric hypercalcemia is often caused by iatrogenic factors, presenting with lower calcium levels. Parathyroid hormone-dependent causes show the lowest phosphate levels, while PTH-independent causes pose diagnostic challenges.
Area of Science:
- Pediatric Endocrinology
- Clinical Biochemistry
- Internal Medicine
Background:
- Hypercalcemia in children is uncommon, has varied causes, and can lead to multi-organ complications.
- Understanding the specific etiologies and clinical presentations is crucial for effective management.
Purpose of the Study:
- To describe the etiology, biochemistry, clinical manifestations, and treatment of hypercalcemia in pediatric patients.
- To classify hypercalcemia causes into iatrogenic, parathyroid hormone (PTH)-independent, and PTH-dependent groups.
Main Methods:
- Retrospective descriptive study of 147 pediatric patients with hypercalcemia from 2008 to 2022.
- Patients were categorized into three groups: iatrogenic (G1), PTH-independent (G2), and PTH-dependent (G3).
- Analysis included calcemia, phosphatemia, clinical symptoms, and treatment requirements.
Main Results:
- Iatrogenesis was the most frequent cause (51.7%), followed by PTH-independent (39.4%) and PTH-dependent (8.8%) etiologies.
- Median calcemia was lowest in the iatrogenic group (11.6 mg/dl).
- Mean phosphatemia was lowest in the PTH-dependent group (3.7 mg/dl).
- Most patients were asymptomatic (71%), and 28.6% required additional treatments.
- Symptomatic cases and those needing extra treatment were less common in the iatrogenic group.
Conclusions:
- Iatrogenic causes are the most prevalent in pediatric hypercalcemia, associated with lower calcium levels.
- PTH-dependent hypercalcemia is linked to the lowest phosphate levels.
- PTH-independent hypercalcemia presents diagnostic and therapeutic challenges due to its non-specific biochemical profile.
Abstract:
Introduction. Hypercalcemia is infrequent in pediatrics, of diverse etiology, and with multiorgan morbidity. Objective. Describe the etiology, biochemistry, clinical, and treatment in pediatric patients with hypercalcemia. Population and methods. Retrospective and descriptive study of a cohort of patients with hypercalcemia between 2008 and 2022. They were classified into three groups (G): hypercalcemia of iatrogenic cause (G1), parathyroid hormone (PTH) independent (G2), or PTH-dependent (G3). Results. One hundred forty-seven patients were included; 57% were male, with a median age of 3.7 years, median calcemia of 11.8 mg/dl, and mean phosphatemia of 4.9 mg/dl. Symptoms were present in 29% of patients, and 28.6% required additional treatments to those of the first line. In G1, 76 patients (51.7%) were included; in G2, 58 (39.4%), and in G3, 13 (8.8%). Median calcemia was lower in G1 vs. G2 and G3 (11.6 mg/dl, 12.6 mg/dl, and 12.3 mg/dl), and mean phosphatemia was lower in G3 vs. G1 and G2 (3.7 mg/dl, 5.3 mg/dl, and 4.9 mg/dl). Most of the patients with hypercalcemia were asymptomatic and did not require additional treatments. The percentage of symptomatic patients and the percentage requiring additional treatment were lower in G1 than in the other two groups. Conclusions. Iatrogenesis was the most frequent cause, presenting lower calcemia, while PTH-dependent causes presented the lowest phosphatemia. PTH-independent causes represented a diagnostic and therapeutic challenge due to lacking a characteristic biochemical profile.
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